HCPCS ( Healthcare Common Procedure Coding System )

HSPCS codes (usually pronounced “hick-pick”) were made by the Centers for Medicare and Medicaid (CMS) and consists of two different code systems. The first HSPCS code system would be the Level 1 HCPSC codes called CPT ( Current Procedural Terminology )

Current Procedural Terminology (CPT®) or Level I HCPCS codes. These codes help physicians bill for the various services and procedures that they provide. The American Medical Association (AMA) is the organization that maintains the CPT codes. Now, these first set codes rarely provide a code for specific products used during a procedure, this is why CMS decided to created a second code set known as Level II HCPCS codes. These Level 2 HCPCS codes are for drugs, supplies, durable medical equipment, and for filling in gaps within the CPT coding system.

Level II HCPCS coding structure starts with a letter and is followed by 4 digits. The specific letter that the code starts with is specific to the type of product.

Medical Diagnosis codes

ICD-9-CM Codes

The International Classification of Diseases, Ninth Revision, Clinical Modification better knows as ICD-9-CM are codes that describe diagnoses that the United States health system's customized from the international ICD-9 standard list.

The reason these codes are standardized is so physicians can improve consistency when diagnosing there patient's symptoms. This helps with clinical research and claims reimbursement.

The ICD-9 codes are 5 digits and range from 000 to 999 according to the type of disease or injury they describe. the type of injury or disease which is called the "the category" is the first 3 digits.

Following a decimal point after the first three digits will be the sub-category which is two digits and offer more in-depth information about the type, location, and severity of the disease or injury.

There are also two alphanumeric codes in ICD-9-CM, which are E codes for external causes of injury and V codes that influence health status and/or describe interactions with health services

If we look up a shoulder pain icd 9 code which is 719.41 and the description would be Pain in the joint, shoulder region

ICD-10-CM (Clinical Modification)

The ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) is again like its predecessor ICD-9-CM is based on the International Classification of Diseases by the World Health Organization.

Each Injury, disease, infection, symptoms, and disorder has its own ICD-10 code. The ICD-10 codes are used for tracking disease epidemics, worldwide mortality statistics, and health insurance claims.

Now like ICD-9-CM, the ICD-10-CM is specifically used in the United States, from the largest hospitals right down to your small-town physician's office.

ICD-10 codes contain 3 to 7 alphanumeric characters, The first 3 characters define the category of the disease, disorder, infection or symptom. While characters 4 to 6 define the body site, the severity of the problem, cause of the injury or disease, and other clinical details. and the 7th character is used for varied purposes such as defining if this the first time this encounter this problem, or another time, was this a result of another condition.

A great example of ICD 10 code would be the osteoarthritis icd 10 code. Let us take a look at the code M19.019 which is a billable ICD code used to specify a diagnosis of primary osteoarthritis, unspecified shoulder.


These codes are used only in the united states and for patients who are in the hospital and are having a procedure done.

DME HCPCS Modifiers

Most HCPCS codes require a modifier to be used when billing. This is to provide more accurate and detailed information in regards to the item.

So of the more common modifiers, you will run into are bellow:

  • RR - Rental

  • NU - Purchase of new equipment

  • UE - Purchase of used equipment

  • MS – Six-month maintenance and servicing fee for reasonable and necessary parts and labor that are not covered under any manufacturer or supplier warranty.

  • RA – Replacement of a DME item due to loss, irreparable damage, or theft. This is used on the first-month rental claim for a replacement item.

  • RB – Replacement of a part of DME as part of a repair

  • RT – Right

  • LT – Left

  • KX – The KX modifier should be added to the code to indicate that specific required documentation is on file to support the medical necessity of the item.

Episode Alert Services

  • Medicare Eligibility - Easily identify if there is are any issues with Patients eligibility with our simple to understand patient summary log.
  • Medicare Claims- Send your Medicare claims securely. Receive an email alert when CMS does not send you a claim report back and if it has been rejected.
  • DDE access - Fast and secure connection to Medicare's DDE/FISS system.
  • Same or Similar checker - Fast and easy way to check beneficiaries have Same or Similar including BatchMode

Service Specific FAQ's

G codes are used to identify professional health care procedures and services that would otherwise be coded in CPT but for which there are no CPT codes.

J codes Are primarily identified as injectable drugs. typically includes drugs that cannot self-administered, are reasonable and necessary for the treatment of the injury or illness and considered effective by the FDA, among other requirements. .

V codes are referred to in the ICD-9 and called Z codes in the ICD-10 are Other Conditions That May Be a Focus of Clinical Attention, addresses issues that are a focus of clinical attention or affect the diagnosis, course, prognosis, or treatment of a patient's mental disorder.

A HCPCS modifier gives a physician or provider the means to show the service or procedure that has been altered in a specific way, but has not changed the code it's self.